Dexamethasone (16 alpha-methyl,9 alpha fluoroprednisolone) in obstructive respiratory tract infections in children. A controlled study

Animal Pneumoviruses: Molecular Genetics and Pathogenesis

“…To this end, glucocorticoids are generally considered to have broad-reaching anti-inflammatory properties and in fact have been the focus of several clinical hRSV trials. Unfortunately, these trials suggest that when used alone in the absence of antivirals, glucocorticoid treatment has only marginal, if any, benefit in the treatment of hRSV-infection and its associated inflammatory response (72,83,84,212,213,231,307,331,334,338,365). A meta-analysis of several these studies demonstrated that systemic glucocorticoids reduced the total length of hospital stay by only 0.43 day per patient, an effect reduced to only 0.29 day per patient when patients with previous episodes of wheezing were excluded from the analysis (137), a statistically significant difference with overall minor clinical impact.…”

Therapy for respiratory tract infections caused by respiratory syncytial virus

“…They found a positive eect of dexamethasone on a severity score, length of oxygen therapy and hospital stay. Some subsequently performed studies could not reproduce their results [40,62,63] while others also found positive eects of corticosteroids in patients with bronchiolitis [9,65]. Due to dierent treatment protocols and variable study populations with unknown proportions of RSV-infected children, these trials are not comparable and may be dicult to interpret.…”

Management of Croup

“…In 1980, Tunnessen and Feinstein [36] evaluated nine studies published in the 1960s and 1970s with regard to methodology. [34,[37][38][39][40][41][42][43][44] Five of the nine studies produced a significant benefit from corticosteroids. [34,[37][38][39][40] There appeared to be three major flaws in these papers.…”

“…Appropriate exclusion criteria did not appear to be present, which may have resulted in diseases other than croup being studied. Secondly, the dose of corticosteroid was not deemed adequate in five of the papers [37,38,[41][42][43] (adequate being defined as hydrocortisone 100mg, [34,36] which is equivalent to dexamethasone 0.3 mg/kg [45] ). Finally, the choice of outcome event was not always adequate to determine a response.…”

“…They 37 patients required no further follow-up; 10 patients were reviewed but no treatment was required; one patient was treated with further epinephrine in the emergency department and discharged; two patients were lost to follow-up; it was not specified which patients received corticosteroids found 10 trials, nine of which could be included in their metaanalysis. [38][39][40][41][42][43][44]47,48] The meta-analysis showed a benefit in using corticosteroids, with outcome measurements of clinical improvement at 12 and 24 hours, and a reduced incidence of endotracheal intubation. Kairys and colleagues also demonstrated a doseresponse effect; however, there was a marked difference in the range of doses used, from dexamethasone 0.08 to 0.8 mg/kg.…”